Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 May;137(5):725-731.
doi: 10.1007/s00402-017-2675-1. Epub 2017 Mar 24.

Functional and patient-reported outcomes of the Swanson metacarpo-phalangeal arthroplasty in the rheumatoid hand

Firas K Elherik  1 , Sean Dolan  2 , John Antrum  3 , Frank Unglaub  4 , Colin R Howie  3 , Steffen J Breusch  3
Affiliations

Functional and patient-reported outcomes of the Swanson metacarpo-phalangeal arthroplasty in the rheumatoid hand

Firas K Elherik et al. Arch Orthop Trauma Surg. 2017 May.

Abstract

Introduction: Replacement of the metacarpo-phalangeal joints (MCPJ) with silastic Swanson's implants can help decrease pain, stiffness and allow for improved function in rheumatoid arthritis (RA). There is a lack of patient reported outcome measure (PROM) studies assessing the efficacy of this procedure in RA. The aim of this study was to report any change in function, pain, stiffness and satisfaction following the Swanson MCPJ replacement using patient reported outcomes in a rheumatoid population.

Methods: The combined results of 64 RA patients (71 hands) with 284 Swanson MCPJ arthroplasties (mean follow-up: 75.85 months) were assessed using the validated M-SACRAH questionnaire and a separate satisfaction questionnaire. Radiographic evaluation was performed to insure correct alignment of the hinged prosthesis postoperatively. No attempt was made to identify other predictors, radiologically or clinically. Data analysed in the study was interpreted in the context of the number of hands and survivorship was defined as implant fracture, loosening or revision.

Results: The mean total functional outcome score improved by 46.2% and the total pain outcome improved by 60.2%. The total stiffness outcome improved by 56.9% postoperatively and the results obtained from the satisfaction questions revealed that 73.2% of patients would retrospectively elect to have the procedure again. We report two postoperative complications in this group of superficial wound infections. Radiographically, all MCPJs showed improved alignment, however five patients reported worsening pain, four patients reported increased stiffness and four reported reduced function postoperatively. There was one re-operation of a 5th MCPJ Swanson's, which did not require implant exchange and one implant was revised. Implant survivorship was 98.6%.

Conclusions: Patient satisfaction and functional surrogate markers were overall favourable. Our results support the continued use of Swanson silastic arthoplasty in advanced RA.

Keywords: M-SACRAH; Metacarpo-phalangeal joint; Patient-reported outcome measures; Rheumatoid arthritis; Silastic implants; Swanson.

PubMed Disclaimer

Conflict of interest statement

The authors have declared no conflict of interest. We confirm that all persons involved in this study gave their informed consent prior to their inclusion in the study and that this study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Figures

Fig. 1
Fig. 1
The end stage rheumatoid MCPJ is classically subluxed or dislocated volarly, fixed in flexion with ulnar deviation of the fingers. Left hand 4 years postpostoperatively, right hand prior surgery
Fig. 2
Fig. 2
The postoperative radiographic appearance of the Swanson silastic MCPJ arthroplasty. Radiographs show no evidence for implant failure
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Rizzo M, Cooney WP. Current concepts and treatment for the rheumatoid wrist. Hand Clin. 2011;27(1):57–72. doi: 10.1016/j.hcl.2010.09.004. - DOI - PubMed
    1. Trail A, Martin JA, Nuttall D, Stanley J. Seven year survivorship analysis of silastic metacarpophalangeal joint replacement. J Bone Joint Surg Br. 2004;86(7):1002–1006. doi: 10.1302/0301-620X.86B7.15061. - DOI - PubMed
    1. Goldfarb CA, Stern PJ. Metacarpophalangeal joint arthroplasty in rheumatoid arthritis. A long-term assessment. J Bone Joint Surg Am. 2003;85-A(10):1869–1878. doi: 10.2106/00004623-200310000-00001. - DOI - PubMed
    1. National Institute for Health and Clinical Excellence (2010) The guidelines manual 2009. NICE, London, pp 4–18
    1. Feldman DE, Bernatsky S, Houde M, Beauchamp ME, Abrahamowicz M. Early consultation with a rheumatologist for RA: does it reduce subsequent use of orthopaedic surgery? Rheumatology. 2013;52:452–459. doi: 10.1093/rheumatology/kes231. - DOI - PubMed

MeSH terms

LinkOut - more resources